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Raiding the Refrigerator, but Still Asleep

Shirley Koecheler, 54, has been a sleepwalker for as long as she can remember. But it wasn’t until she got married that she started eating in her sleep, too. She’d wander into the kitchen — eyes open but asleep — and binge on junk food.

Like so many of those with sleep-related eating disorder, Ms. Koecheler, a businesswoman and farmer from Maple Plains, Minn., does not remember anything about her nighttime journeys. When she wakes up the next morning to a crumb-filled bed, uncomfortably full, she knows that she must have spent the night feasting.

“I’ve gained seven pounds in the past two months,” Ms. Koecheler said. “I bought the Easter candy for the kids and had my husband hide it, but I must have found it during the night. I found the wrappers in the wastebasket from the solid chocolate bunnies.”

Sleep eaters “make a beeline for the kitchen” and tend to binge on sugary, high-calorie snacks, sometimes five times a night, said Dr. John W. Winkelman, medical director of the Sleep Health Center of Brigham and Women’s Hospital in Brighton, Mass. Some go for bizarre food combinations like peanut butter and pasta, and even the occasional nail polish or paper.

Consequences of nighttime eating can include injuries like black eyes from walking into a wall or hand cuts from a prep knife, or dental problems from gnawing on frozen food. On a deeper level, many sleep eaters feel depressed, frustrated and ashamed. Upwards of 10 percent of adults suffer from some sort of parasomnia, or sleep disorder, like sleepwalking or night terrors. Some have driven cars or performed inappropriate sexual acts — all while in a sleep-induced fog. About 1 percent, mostly women, raid the refrigerator.

No one knows what triggers these nocturnal escapades, but recent research offers a glimmer of light into the basic biology. And while there are no cures, some medications are showing promise for helping sufferers sleep more soundly. Oddly enough, sleeping pills do not help — the sedative Ambien, in fact, has been known to trigger or exacerbate the problem.

In “Sleep Runners,” a 2004 documentary about parasomnias, 75-year-old Rowena Pope of Circle Pines, Minn., recalls how one night her usually gentle husband, Cal, “began pummeling me and kicking me violently. I shook him and awakened him, and he had no idea what he was doing.”

Dr. Carlos H. Schenck, a professor of psychiatry at the University of Minnesota and the film’s producer, said that violence during the night does not signify lurking aggression. Similarly, eating during sleep does not necessarily signal a daytime eating disorder, though sleep eating may be more common among people with disorders like binge eating or anorexia.

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Sadly, many sleep eaters and others with related disorders suffer for years without telling their doctors because they consider it a personality quirk rather than a medical disorder. They may try all sorts of remedies, from strapping themselves to the bed to hiding food, usually to little or no avail.

Others worry they’ll be labeled with a mental illness, a notion that mental health experts now dismiss. “Those who exhibit violence during sleep, or scream, or swear, or masturbate, or eat frozen ravioli, or wander into the hallway in their underwear while asleep generally have no more of a psychological disorder than those who sleep peacefully every night,” Dr. Schenck writes in his book “Sleep: The Mysteries, the Problems and the Solutions” (Penguin/Avery, 2007).

“I thought this was just the way I was,” said Sarah Tracey, a 22-year-old radiation therapist and sleep eater from Canton, Mass. “I usually get up four or five times a night. I’ve been doing it since I was 11 or 12-ish.” When she worried that her disturbed sleep would affect her job performance, she did what so many others do - she searched online, where she found an article about sleep eating as well as an ongoing study about the disorder. “It was a huge relief to realize that it’s a real condition and I’m not being crazy.”

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Scientists now divide parasomnias into two main groups, depending on whether or not they occur during the rapid eye movement, or REM, phase of sleep, when dreaming occurs. About 0.5 percent of adults, mostly men, have a rare condition called REM sleep behavior disorder that causes violent thrashing during sleep.

There are other REM disorders, including nightmare disorder, marked by horribly disturbing dreams. One of the most terrifying parasomnias, Dr. Schenck said, is sleep paralysis, which really does not fit into either of the main categories. It hits people as they are about to fall asleep or are about to wake up, rendering them unable to move.

Clonazepam, an anticonvulsant and anti-anxiety medication, helps up to 90 percent of people with REM sleep behavior disorder, though it makes some people drowsy the following day. Cal Pope, the sleep thrasher in the parasomnia documentary, has taken the pills successfully for years, though Dr. Schenck cautions that when people stop taking the drug, even for a few days, the sleep violence can return immediately.

Recent evidence also suggests that REM sleep behavior disorder may be an early harbinger of Parkinson’s disease or other neurodegenerative disorders linked to defects in the dopamine system in the brain. These clues have prompted some experts to use drugs like pramipexole (Mirapex) that boost dopamine levels to treat people who thrash in their sleep. In a small study published in Sleep Medicine, Dr. Markus H. Schmidt, the medical director of the Ohio Sleep Medicine Institute, found that pramipexole helped nine of 10 volunteers.

Non-REM sleep disorders include the sleep eaters and those with so-called sexsomnia, in which people can hurt themselves from violent masturbation or injure their bed partner with aggressive sexual behavior, all done in a sleep-like state. Unlike REM sleep behavior disorder, non-REM sleep disturbances occur when the patient is not dreaming, and their eyes may be open. As Dr. Schmidt put it, they are in a kind of no-man’s land,. not fully awake nor fully asleep.

One of the biggest stumbling blocks is that no one really understands what happens during sleep. As Dr. Winkelman explained, “Sleep is not the absence of wake. Your brain is active all night long. People think wake is like a room with the lights on and sleep is like the same room in the dark, but in the darkness a lot is going on.”